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1.
Philos Ethics Humanit Med ; 15(1): 7, 2020 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-32900388

RESUMO

BACKGROUND: Normally, physicians understand they have a duty to treat patients, and they perform accordingly consistent with codes of medical practice, standards of care, and inner moral motivation. In the case of COVID-19 pandemic in a developing country such as Bangladesh, however, the fact is that some physicians decline either to report for duty or to treat patients presenting with COVID-19 symptoms. At issue ethically is whether such medical practitioners are to be automatically disciplined for dereliction of duty and gross negligence; or, on the contrary, such physicians may legitimately claim a professional right of autonomous judgment, on the basis of which professional right they may justifiably decline to treat patients. METHODS: This ethical issue is examined with a view to providing some guidance and recommendations, insofar as the conditions of medical practice in an under-resourced country such as Bangladesh are vastly different from medical practice in an industrialized nation such as the USA. The concept of moral dilemma as discussed by philosopher Michael Shaw Perry and philosopher Immanuel Kant's views on moral appeal to "emergency" are considered pertinent to sorting through the moral conundrum of medical care during pandemic. RESULTS: Our analysis allows for conditional physician discretion in the decision to treat COVID-19 patients, i.e., in the absence of personal protective equipment (PPE) combined with claim of duty to family. Physicians are nonetheless expected to provide a minimum of initial clinical assessment and stabilization of a patient before initiating transfer of a patient to a "designated" COVID-19 hospital. The latter is to be done in coordination with the national center control room that can assure admission of a patient to a referral hospital prior to ambulance transport. CONCLUSIONS: The presence of a moral dilemma (i.e., conflict of obligations) in the pandemic situation of clinical care requires institutional authorities to exercise tolerance of individual physician moral decision about the duty to care. Hospital or government authority should respond to such decisions without introducing immediate sanction, such as suspension from all clinical duties or termination of licensure, and instead arrange for alternative clinical duties consistent with routine medical care.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Obrigações Morais , Pandemias , Médicos/ética , Pneumonia Viral , Recusa do Médico a Tratar/ética , Bangladesh , Humanos , Autonomia Profissional
2.
BMJ Open ; 10(9): e039711, 2020 09 14.
Artigo em Inglês | MEDLINE | ID: mdl-32928867

RESUMO

OBJECTIVES: High levels of organisational citizenship behaviour can enable nurses to cooperate with coworkers effectively to provide a high quality of nursing care during the outbreak of COVID-19. However, the association between autonomy, optimism, work engagement and organisational citizenship behaviour remains largely unexplored. This study aimed to test if the effect of autonomy on organisational citizenship behaviour through the mediating effects of optimism and work engagement. STUDY DESIGN: This was a cross-sectional study. SETTING: The study was conducted in the Wuhan Jinyintan Hospital in China. PARTICIPANTS: In total, 242 nurses who came from multiple areas of China to work at the Wuhan Jinyintan hospital during the COVID-19 epidemic participated in this study. METHODS: A serial mediation model (model 6) of the PROCESS macro in SPSS was adopted to test the hypotheses, and a 95% CI for the indirect effects was constructed by using Bootstrapping. RESULTS: The autonomy-organisational citizenship behaviour relationship was mediated by optimism and work engagement, respectively. In addition, optimism and work engagement mediated this relationship serially. CONCLUSION: The findings of this study may have implications for improving organisational citizenship behaviour. The effects of optimism and work engagement suggest a potential mechanism of action for the autonomy-organisational citizenship behaviour linkage. A multifaceted intervention targeting organisational citizenship behaviour through optimism and work engagement may help improve the quality of nursing care among nurses supporting patients with COVID-19.


Assuntos
Comportamento Cooperativo , Infecções por Coronavirus/enfermagem , Enfermeiras e Enfermeiros/psicologia , Otimismo/psicologia , Pneumonia Viral/enfermagem , Autonomia Profissional , Engajamento no Trabalho , Atitude do Pessoal de Saúde , Betacoronavirus , China , Humanos , Pandemias , Comportamento Social , Inquéritos e Questionários
3.
Tijdschr Gerontol Geriatr ; 51(1)2020 Mar 16.
Artigo em Holandês | MEDLINE | ID: mdl-32951390

RESUMO

Depression is highly prevalent in nursing homes residents and affects their quality of life. Both prevalence and impact of depression may decrease when effective guidelines or depression care programs are used, but this appears to be a challenging task. The Self Determination Theory postulates that the realization of complex tasks is being facilitated by meeting three basic human psychosocial needs: autonomy, competence and relatedness to others. This cross-sectional study investigates the relationship between the experienced autonomy, competence and relatedness and the extent to which depression care is given according to guidelines in 46 doctors, 49 psychologists and 53 nurses from 71 Dutch nursing homes. Although autonomy and competence were significantly related to depression care according to guidelines, hierarchical multiple regression analyses with all three basic needs showed a statistically significant result for competence only. The associations don't allow conclusions about causal relationships, longitudinal research will shed light on the direction of the association for competence.


Assuntos
Depressão , Guias de Prática Clínica como Assunto , Autonomia Profissional , Estudos Transversais , Depressão/terapia , Humanos , Casas de Saúde , Autonomia Pessoal , Qualidade de Vida
4.
Policy Polit Nurs Pract ; 21(4): 222-232, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32910736

RESUMO

Across the United States, nursing practice acts (NPAs) have been revised to include provisions that promote full practice authority (FPA) for nurse practitioners (NPs). Such revisions provide a mechanism to better utilize the full scope of NP services to address growing demands for access to health care. Modernized NPAs that facilitate FPA for NPs are imperative, especially now with the unprecedented health care crisis that the world now faces: Coronavirus Disease 2019. This is the first known study to use an embedded single-case study design, guided by the Kingdon policy stream model, to provide a detailed account of how stakeholders for NP FPA determine the appropriate time to pursue legislative changes to NP scope of practice regulations. Qualitative data analysis revealed four themes which comprised the components considered by stakeholders during their decision-making processes related to NP FPA: participants, problem, policy development, and politics. Themes were further collapsed within concepts from the Kingdon model to form the case description. Study findings can be used to increase the competency among NP FPA stakeholders in determining the timing of legislative pursuits for regulatory change.


Assuntos
Betacoronavirus , Infecções por Coronavirus/enfermagem , Profissionais de Enfermagem/legislação & jurisprudência , Pneumonia Viral/enfermagem , Padrões de Prática em Enfermagem/legislação & jurisprudência , Autonomia Profissional , Política de Saúde/legislação & jurisprudência , Humanos , Pandemias , Estados Unidos
6.
Artigo em Inglês | MEDLINE | ID: mdl-32842676

RESUMO

This study aimed to investigate changes in nurses' attitudes toward professional autonomy and occupational commitment over time, and their effect on nurses' intentions to leave, using a two-wave longitudinal design. Anonymous, self-report questionnaires were distributed to all nurses working at 28 hospitals in western Japan on two separate occasions (n = 1778). Multivariate analysis using a generalized estimation equation was conducted, with the intention to leave at Time 2 as the dependent variable, and the changing secular trends in all subscales of attitudes toward professional autonomy and occupational commitment as the independent variables. Age, sex, education, and intention to leave at Time 1 were control variables. Results showed that increasing changing secular trends in control over work conditions, which is a subscale of attitudes toward professional autonomy, increased intention to leave at Time 2, while increasing changing secular trends in all subscales of occupational commitment decreased intention to leave at Time 2. Nurses with a progressive attitude toward discretion of control over work conditions may have higher intentions to leave. Therefore, increasing control over their work conditions may reduce this intention. Additionally, it is necessary to continually enhance nurses' occupational commitment by offering professional development programs.


Assuntos
Intenção , Recursos Humanos de Enfermagem no Hospital , Autonomia Profissional , Atitude do Pessoal de Saúde , Estudos Transversais , Humanos , Japão , Satisfação no Emprego , Estudos Longitudinais , Inquéritos e Questionários
7.
Nurs Educ Perspect ; 41(5): 285-290, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32701633

RESUMO

AIM: The aim of the study was to investigate the role of Kanter's theory of workplace empowerment in nurses' attitude toward returning to school. BACKGROUND: Increasing the percentage of BSNs has a positive effect on outcomes, but few hospitals offer formal support systems beyond tuition reimbursement. Workplace empowerment theory may explain attitudes toward returning to school. METHOD: A mixed-methods design was used with a cross-sectional survey and focus group. RESULTS: Significant predictors of attitude toward returning to school (n = 162) were formal power (p = .003), access to support (p = .007), and access to resources (p = .050). Focus group themes (n = 3) were resources important to returning to school/manager support, timing, becoming aware of opportunities after enrolling, and intrinsic desire to return to school. CONCLUSION: Exploring relationships between workplace empowerment and attitudes toward returning to school will guide hospital executives in building support systems for nurses returning to school.


Assuntos
Educação em Enfermagem , Poder Psicológico , Autonomia Profissional , Estudos Transversais , Empoderamento , Humanos , Inquéritos e Questionários
9.
Nurs Outlook ; 68(4): 459-467, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32593462

RESUMO

BACKGROUND: Full practice authority laws that permit nurse practitioners (NPs) to practice independently and prescribe medications may influence NPs' workforce outcomes. PURPOSE: To examine whether implementation of full practice authority laws affect NP self-employment, average earnings, and likelihood of residing in a primary care health professional shortage area (HPSA). METHODS: A nationally representative U.S. sample of 9,782 NPs employed in health care during 2010 to 2018 was drawn from the American Community Survey. Difference-in-differences regression was used to estimate covariate-adjusted mean differences in NPs' workforce outcomes after full practice authority implementation. FINDINGS: Among full-time employed NPs, full practice authority was associated with an increased probability of residing in a HPSA (adjusted odds ratio [aOR]:2.34, 95%CI 1.14, 4.83) and with a higher mean probability of self-employment (aOR:4.97, 95%CI 1.00, 24.86). DISCUSSION: Full practice authority implementation improves access to primary care providers in health professional shortage areas and may increase practice ownership among NPs.


Assuntos
Profissionais de Enfermagem/estatística & dados numéricos , Profissionais de Enfermagem/normas , Autonomia Profissional , Competência Profissional/estatística & dados numéricos , Competência Profissional/normas , Papel Profissional , Recursos Humanos/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos
11.
Enferm. foco (Brasília) ; 11(1): 21-26, jun. 2020.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1102459

RESUMO

Objetivo: Analisar o significado da prática do histórico de enfermagem em uma Unidade de Terapia Intensiva. Método: Estudo qualitativo, realizado em uma Unidade de Terapia Intensiva do sul do Brasil, com nove enfermeiros. A coleta de dados ocorreu por meio de grupo de discussão, tendo como questão disparadora: O que significa a prática do Histórico de Enfermagem na Unidade de Terapia Intensiva? Os dados foram analisados por meio do Discurso do Sujeito Coletivo. Resultados: O estudo deu origem a três discursos com as ideias centrais: O histórico de enfermagem representa a qualificação do cuidado e o empoderamento da enfermagem; A informação como ferramenta do cuidado; O instrumento utilizado para o histórico de enfermagem como construção coletiva. Considerações Finais: O histórico de enfermagem como boa prática confere à profissão, autonomia, empoderamento e visibilidade. Ademais, qualifica e assegura o cuidado oferecido respaldando o exercício profissional. (AU)


Objective: To analyze the meaning of nursing practice in an Intensive Care Unit. Method: Qualitative study, conducted in an Intensive Care Unit in the south of Brazil, with nine nurses. The data collection took place through a discussion group, having as a triggering question: What does the practice of Nursing History in the Intensive Care Unit? The data were analyzed through the Collective Subject Discourse. Results: The study gave rise to three discourses with the central ideas: Nursing history, nursing qualification and empowerment; Information as a care tool; The nursing history as a collective construction. Final Considerations: The nursing history as a good practice confers on the profession, autonomy, empowerment and visibility. (AU)


Objectivo: Analizar el significado de la práctica del historial de enfermería en una Unidad de Terapia Intensiva. Método: Estudio cualitativo, realizado en una Unidad de Terapia Intensiva del sur de Brasil, con nueve enfermeros. La recolección de datos ocurrió por medio de un grupo de discusión, teniendo como cuestión desencadenadora: Qué significa la práctica del Historial de Enfermería en la Unidad de Terapia Intensiva? Los datos fueron analizados por medio del Discurso del Sujeto Colectivo. Resultados: El estudio dio origen a tres discursos con las ideas centrales: El histórico de enfermería, la calificación del cuidado y el empoderamiento de la enfermería; La información como herramienta del cuidado; El histórico de enfermería como construcción colectiva. Consideraciones finales: El historial de enfermería como buena práctica confiere a la profesión, autonomía, empoderamiento y visibilidad. (AU)


Assuntos
Processo de Enfermagem , Autonomia Profissional , Unidades de Terapia Intensiva , Cuidados de Enfermagem
12.
Rev. Rol enferm ; 43(5): 363-370, mayo 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-193624

RESUMO

Este artículo describe la percepción de los estudiantes de enfermería sobre los tipos de prejuicios experimentados con relación a la enfermería. METODOLOGÍA: Estudio exploratorio con un enfoque cualitativo, llevado a cabo en una institución de educación superior privada, en Belém-Pa (Brasil), de mayo a noviembre de 2019, a través de una entrevista semiestructurada, con muestreo de saturación, en un total de 30 participantes. Los datos se analizaron utilizando el método de Bardin. RESULTADOS: Se enumeraron cuatro categorías, a saber: 'Elección de la profesión', 'Tipos de prejuicio', 'Las causas y / o razones de los prejuicios experimentados en la profesión' y 'Las estrategias para hacer frente a los prejuicios. CONCLUSIÓN: Existe una necesidad urgente de abordar formas de combatir los prejuicios durante la licenciatura, teniendo en cuenta su prevalencia e impacto, para que las/os profesionales y estudiantes de enfermería tengan más seguridad y autonomía para desarrollar su trabajo con más motivación y entusiasmo


This article describes the perception of nursing students about the types of prejudices experienced in relation to nursing. METHODOLOGY: Exploratory study with a qualitative approach, carried out at a private higher education institution, in Belém-Pa (Brazil), from May to November 2019, through a semi-structured interview, with saturation sampling, in total of 30 participants. Data will be analyzed using the Bardin method. RESULTS: Four categories were listed, which are: 'Choice of profession', 'Types of prejudice', 'The causes and / or reasons of prejudice experienced in the profession' and 'Strategies for dealing with prejudice'. CONCLUSION: There is an urgent need to address ways to combat prejudice during undergraduate studies, taking into account its prevalence and impact, so that nursing professionals and students have more security and autonomy to carry out their work with more motivation and enthusiasm


Assuntos
Humanos , Percepção , Estudantes de Enfermagem/psicologia , Preconceito/psicologia , Autonomia Profissional , 25783 , Análise de Dados , Estereotipagem
13.
J Surg Res ; 252: 174-182, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32278972

RESUMO

BACKGROUND: It is expected that graduating general surgery residents be confident in performing common abdominal wall hernia repairs. The objective of our study was to assess the confidence of senior surgical residents in these procedures and to identify factors that correlate with confidence. METHODS: We performed a cross-sectional survey of PGY-4 and PGY-5 general surgery residents at ACGME-accredited programs in the United States in the spring of 2019. Respondents rated their confidence level in 12 hernia procedures on a Likert scale from 1 (not confident) to 5 (extremely confident). Respondents were classified as "Not Confident" (Not Confident, Minimally Confident, Neutral responses) or "Confident" (Confident, Extremely Confident responses). Resident characteristics, program characteristics, and operative experience were collected, and we calculated the area under the curve to screen which factors discriminated between those confident versus not. Multivariable Poisson regression was used to estimate prevalence ratios (PR) and 95% confidence intervals (CI) to identify which factors were most predictive. RESULTS: A total of 93 surveys were completed. Respondents reported low confidence rates (25%-60%) in the following hernia repairs: minimally invasive (MIS) inguinal, femoral, tissue (nonmesh) inguinal, pediatric inguinal, and abdominal wall reconstruction. High confidence rates (>80%) were reported for open umbilical, open ventral, and MIS ventral hernia repairs. For MIS inguinal hernia repair, PGY-5 level was associated with a twofold increase in confidence (PR = 2.01; 95% CI = 1.34-3.30), and dedicated research years were associated with low confidence (PR = 0.67; 95% CI = 0.43-1.04). In general, higher operative volumes of a specific repair were associated with increased confidence in that procedure. CONCLUSIONS: Senior surgical residents reported low confidence in performing a variety of essential hernia repairs (particularly MIS inguinal, femoral, and tissue inguinal). Addressing factors associated with low confidence may help increase resident confidence.


Assuntos
Cirurgia Geral/educação , Hérnia Abdominal/cirurgia , Herniorrafia/psicologia , Internato e Residência/estatística & dados numéricos , Autonomia Profissional , Adulto , Competência Clínica/estatística & dados numéricos , Estudos Transversais , Feminino , Herniorrafia/métodos , Herniorrafia/estatística & dados numéricos , Humanos , Masculino , Estados Unidos
14.
Artigo em Inglês | MEDLINE | ID: mdl-32252355

RESUMO

The study aimed to investigate the situation of nurse prescribing, introduced in Poland in 2016, by analyzing the opinions of nurses, expected to be influential on nurses' actual practices, in response to legislative change to enable nurses to prescribe and comparing this with actual nurse prescribing behaviours during the early years of the legislation. The paper fills a knowledge gap and provides baseline data analysis for subsequent research. Nurses' opinions were collected during the period they were preparing themselves for prescribing. That data was compared with data on the character and extent of nurses' actual prescribing practices over the first two years of implementation. The study showed the number of nurse prescriptions increased. Comparing the first and second years of nurse prescribing, the number of nurse independent prescriptions more than doubled. Over the same period, the number of nurse supplementary prescriptions increased almost six-fold. The implementation of nurse prescribing has increased the scope of nursing care, especially in the treatment of the infections, pain and chronic conditions in the elderly.


Assuntos
Prescrições de Medicamentos , Papel do Profissional de Enfermagem , Autonomia Profissional , Adulto , Atitude do Pessoal de Saúde , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polônia , Inquéritos e Questionários , Adulto Jovem
15.
Emerg Med Clin North Am ; 38(2): 339-351, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32336329

RESUMO

Supervision of resident physicians is a high-risk area of emergency medicine, and what constitutes appropriate supervision is a complex question. In this article, policies and procedures for appropriate supervision of resident physicians and the implications for billing are reviewed. Recommendations on supervision of resident physicians in the emergency department are detailed, with attention paid to addressing challenges in balancing patient safety with resident autonomy and education during the course of patient care and graduate medical education.


Assuntos
Serviço Hospitalar de Emergência/organização & administração , Internato e Residência/organização & administração , Humanos , Autonomia Profissional , Gestão de Riscos
16.
Am J Surg ; 219(5): 846-850, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32139104

RESUMO

INTRODUCTION: Teaching assistant (TA) cases allow senior residents (SR) to gain autonomy. We compared the safety profiles of TA cases performed under direct vs. indirect staff supervision. METHODS: Prospective observational study of operative cases where a SR served as the TA between 7/2014-6/2017 (n = 161). Patient/operative characteristics, 30-day outcomes, and SR survey data were compared by level of supervision. RESULTS: Case mix included 68 laparoscopic appendectomies (42%), 49 laparoscopic cholecystectomies (30%), 10 I&Ds (6%), 10 umbilical hernia repairs (6%), 4 port placements (3%), and 11 others. Indirectly supervised cases were shorter (61 vs. 76 min, p < 0.01), with less blood loss (11 vs. 24 ml, p < 0.05), and lower conversion rates (0% vs. 5.7%, p < 0.05). Perceived difficulty was high in 20% of cases with indirect vs. 49% with direct supervision (p < 0.01). Mean SR comfort was high (4.4 vs. 4.6 out of 5) regardless of level of staff supervision. 30-day complications did not differ for indirect vs. direct supervision (all p = NS). DISCUSSION: Carefully selected TA cases offer SRs opportunities to practice autonomy without sacrificing operative time or patient safety.


Assuntos
Competência Clínica , Cirurgia Geral/educação , Internato e Residência , Papel do Médico , Autonomia Profissional , Ensino , Adulto , Feminino , Humanos , Masculino , Estudos Prospectivos
17.
Invest Educ Enferm ; 38(1)2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32124573

RESUMO

OBJECTIVES: This article explored and compared social representations of nurses held by incoming and outgoing Nursing students in the Technical Nursing Program in San Juan, Argentina. METHODS: Our research was descriptive and utilized the prototypicality method of analysis for social representations, from a structural approach. The sample was made up of 194 students (104 incoming and 90 outgoing), to whom we applied the word association technique for the term "nurse". RESULTS: Differences were found in the representations that incoming and outgoing students had. i) For incoming students: we observe a wide and general concept of a nurse, expressed in non-specific terms such as "health" in the central core, while for outgoing students the term "care" emerged; ii) We infer distancing from the hegemonic medical model on the part of outgoing students, as well as an emphasis on the relational, as terms such as "vocation", "humanization", "love" and "empathy" are evoked, while the term "illness" decreases; iii) We understand that outgoing students highlight their autonomy with respect to doctors and nursing as a profession with the term "professional" with no mention of "assistance", "help" and "assistant", terms which did appear with incoming students; iv) Outgoing students convey a sense of a nurse's diverse roles that go beyond the hospital setting, as instead of mentioning "hospital" and "injection" like incoming students, they mention "prevention" and "research". CONCLUSIONS: The comparison of representative structures held by incoming and outgoing students suggests a transformation of self-image through a process of academic education.


Assuntos
Percepção Social , Estudantes de Enfermagem/psicologia , Testes de Associação de Palavras , Adolescente , Adulto , Argentina , Estudos Transversais , Feminino , Humanos , Masculino , Autonomia Profissional , Semântica , Terminologia como Assunto , Adulto Jovem
18.
Nurse Educ Today ; 88: 104389, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32193068

RESUMO

BACKGROUND: The ethical and moral complexities are inherent to nursing practice. Ethical dilemmas of professional nurses and nursing students' ethical concerns with their preceptors are well-documented. No reviews have synthesized students' ethical dilemmas regarding patient care. OBJECTIVES: This review aimed to develop a comprehensive understanding of nursing students' ethical dilemmas regarding patient care in clinical settings. DESIGN: An integrative review based on Whittemore and Knafl's methodology. DATA SOURCES: Literature was searched within PubMed, CINAHL, Google Scholar, Scopus, and Science Direct databases and 13 articles including eight qualitative, three quantitative, one mixed methods and one secondary data analysis were reviewed. The articles were published from January 2000-March 2019. REVIEW METHODS: The Mixed Methods Critical Appraisal Tool was used for quality assessment. Two reviewers independently reviewed the articles and the third reviewer validated the extracted and synthesized findings. Literature summary tables were developed for data extraction and thematic synthesis techniques and narratives were used for data synthesis. For synthesis, findings from strongly and moderately rated studies were given more weight and those from the low-quality studies were used to support the synthesized themes. RESULTS: Three themes emerged: a) applying learned ethical values vs. accepting unethical practices, b) desiring to provide ethical care but lacking autonomous decision making, and c) Silence vs. whistleblowing patient care neglects. CONCLUSIONS: Nursing students feel torn between the conflicts of whether to provide ethical care or accept unethical practices, stay silent about patient care neglect or confront and report it, provide ethical and quality care or adapt to the culture due to lack of autonomous decision making. Such conflicts can be detrimental to students' professional learning and mental health. Therefore, educators and nursing institutions should develop programs to support students and help them develop ethical competence and courage to confront such dilemmas.


Assuntos
Ética em Enfermagem , Estudantes de Enfermagem/psicologia , Tomada de Decisões/ética , Humanos , Negociação , Autonomia Profissional , Pesquisa Qualitativa
19.
J Am Assoc Nurse Pract ; 32(2): 113-119, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32015277

RESUMO

BACKGROUND: Nurse practitioner (NP) autonomy is often misunderstood and misconstrued. These misconceptions cause a confusing interplay of words that impedes advocating for policy change and ultimately hinders the profession. OBJECTIVE: To develop a clear definition of NP autonomy to describe the professional role. DATA SOURCES: Walker and Avant's method of concept analysis was used to undertake a concept analysis of NP autonomy. The terms used to search for possible uses and definitions of NP autonomy in electronic databases included NP, autonomy, and concept analysis. In addition, the websites for nursing organizations, Google, Google Scholar, and the Merriam-Webster dictionary were searched and included in this analysis. This search yielded 29 articles, consisting of literature reviews, meta-synthesis, position papers, and qualitative and quantitative studies. CONCLUSIONS: Nurse practitioner autonomy should be defined as the NP's use of their experience, clinical judgment, and responsibility to practice without restriction in professional collaboration with other health care professionals. Autonomy allows NPs to practice to the maximum extent of their advanced education, participate in productive and voluntarily collaborations, and continue to positively influence health care discrepancies throughout the United States. IMPLICATIONS FOR PRACTICE: This concept analysis provides a clear definition of NP autonomy. In addition, it explains the difference between the concepts of NP autonomy and full practice authority. Clear definitions of the concepts of NP autonomy and full practice authority will be beneficial in advocating and advancing policy on behalf of NPs.


Assuntos
Formação de Conceito , Profissionais de Enfermagem/tendências , Papel do Profissional de Enfermagem/psicologia , Autonomia Profissional , Humanos , Profissionais de Enfermagem/normas
20.
Nurse Educ Today ; 87: 104346, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32058882

RESUMO

Nursing clinical placements provide a unique opportunity for students to develop and hone the skills and knowledge that will be used upon graduation in their future professional practice. There is an on-going inquiry into elements that may facilitate better leaning outcomes in a variety of teaching and learning settings, including clinical experiences. Using a Self-Determination Theory approach, this study examined whether undergraduate nursing students would benefit from immersion in an autonomy-supportive clinical setting. Using a two-group pre and post-test design, students were classified into either an autonomy-supportive or comparison clinical placement cohort and measured on their learning using the Mental Health Clinical Placement Survey. Results of a repeated measures multivariate analysis of variance indicated a significant difference on some of the measures of learning housed within the Mental Health Clinical Placement Survey with students in the autonomy-supportive group reporting higher scores at the post-test time point. Findings support the value that teaching and learning in an autonomy-supportive setting has, on the skills and educational development of students.


Assuntos
Estágio Clínico , Avaliação Educacional/estatística & dados numéricos , Serviços de Saúde Mental , Autonomia Pessoal , Autonomia Profissional , Estudantes de Enfermagem/psicologia , Competência Clínica/normas , Estudos de Coortes , Bacharelado em Enfermagem , Humanos , Teoria Psicológica
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